West and Central Africa faces worst meningitis epidemic in five years

Dakar, 17 April 2009 - An emergency response to combat a virulent outbreak of meningitis affecting four countries in West and Central Africa has been started by UNICEF and other humanitarian agencies.

The agency is warning that lives in other countries of the Meningitis Belt could be at risk if more vaccines are not made available to contain the disease.

From the latest figures available (week ending April 5th), a total of 47,310 cases and 2,519 deaths have been reported since the beginning of the year.

The 2008-2009 meningitis season started earlier than previous seasons and there have been more reported cases than in previous seasons.

• Nigeria is the most affected with 35,255 cases and 1,701 deaths.• Niger reports 8,292 cases and 327 deaths. However, a decreasing trend in number of new cases has been observed for two weeks.• Burkina Faso reports 2,892 cases and 389 deaths. • Chad reports 871 cases and 102 deaths.• Meningitis cases were also notified in the Central African Republic, Côte d’Ivoire, Mali and Togo.

In Nigeria, Niger and Burkina Faso, case management and mass vaccination campaigns are underway. In Chad, there is particular concern as no vaccine is currently available in the country. This explains a particularly high mortality rate associated with the outbreak in the country (lethality rate of 11%).

More vaccines and funding neededThe International Coordination Group for meningitis (ICG), with representatives of UNICEF, WHO, MSF and IFRC, have so far approved a total of 9,140,000 doses of vaccine from the limited global stockpile for outbreak response, as compared to a total of 2,053,000 doses in the entire 2007-2008 season.

However, it is expected that more vaccine will be needed. In Nigeria, the gap is estimated at 2.5 million vaccines. In Niger, another 300,000 doses are needed.

A minimum of $5 million is needed to cover the cost of the urgent needs in additional vaccines and antibiotics in Chad, Niger and Nigeria*.

Active surveillance is overseen by national governments, with the support of WHO. UNICEF procures vaccines and antibiotics for case management and prevention. UNICEF, WHO, IFRC, and MSF support governments in outbreak response.

UNICEF is actively involved in mobilizing funds and procuring needed vaccines and antibiotics. To date, UNICEF has supported the governments in procuring a total of 3.5 million vaccines for Burkina Faso (1), Niger (1) and Nigeria (1.5) and has also donated an additional 160,000 doses to Nigeria and 550,000 doses to Niger.

*This amount breakdowns as follows: $1.8 million for Chad, $458,000 for Niger and $2.75 million for Nigeria.

***Background The diseaseThe disease causes inflammation of the lining of the brain and spinal cord. An airborne bacterial form, meningococcal meningitis is easily spread through droplets of respiratory or throat secretions, especially sneezing and coughing. The disease mainly affects children and young adults aged 1-30.

Symptoms include stiff neck, high fever, headaches, vomiting and sometimes seizures. Even when the disease is diagnosed early and adequate therapy instituted, 5% to 10% of patients die, typically within 24-48 hours of onset of symptoms, according to WHO. Most victims suffer irreversible neurological consequences. Epidemic strains A, C and W135 are now the main serogroups observed in Africa.

For this ongoing outbreak, the epidemic strain A has been identified in Nigeria, Niger. In Chad, the strain W135 and A have been identified whereas in Burkina Faso, most cases are streptococcus pneumoniae with some new cases of the strain A.

The epidemicThe Sahelo-Sudanian band of Africa is an endemic area for meningococcal meningitis. The so-called "African meningitis belt" stretches from Mauritania in the west to Ethiopia in the east and is home to about 350 million people.

Outbreaks occur every year between December and May. The dry season, with strong dusty winds and cold nights make people more prone to respiratory infections and facilitates the spread of bacteria.

The largest recorded outbreak of epidemic meningitis was recorded in Africa in 1996, with over 250,000 cases and 25,000 deaths registered.

Preparedness and responsePreparedness for meningitis epidemics is difficult because vaccines cannot be administered until the different forms of the bacterium spreading are known.

Surveillance and the establishment of stock of vaccines and antibiotics are essential to the preparedness efforts.

The current WHO recommendation for outbreak control is to mass vaccinate every district that is in an epidemic phase, as well as those contiguous districts that are in alert phase. It is estimated that a mass immunization campaign, promptly implemented, can avoid 70 per cent of cases.

Outbreak response also includes active surveillance and case management and support to community awareness programmes.

Once the disease is contracted, it can be treated in its early stages with antibiotics. WHO recommends oily chloramphenicol as the drug of choice in areas with limited health facilities.

A preventive vaccine is available against the serogroups A, C and W135. However quantities available worldwide are limited.

About UNICEF UNICEF is on the ground in over 150 countries and territories to help children survive and thrive, from early childhood through adolescence. The world’s largest provider of vaccines for developing countries, UNICEF supports child health and nutrition, safe water and sanitation,, quality basic education for all boys and girls, and the protection of children from violence, exploitation, and HIV/AIDS. UNICEF is funded entirely by the voluntary contributions of individuals, businesses, foundations and governments.